Document Detail


Acute kidney injury in adult postcardiotomy patients with extracorporeal membrane oxygenation: evaluation of the RIFLE classification and the Acute Kidney Injury Network criteria.
MedLine Citation:
PMID:  19692267     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Acute kidney injury (AKI) is one of the major complications in adult postcardiotomy patients on extracorporeal membrane oxygenation (ECMO) support. The RIFLE (the Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function and End-Stage Kidney Disease) classification and the Acute Kidney Injury Network (AKIN) criteria were proposed to identify and classify AKI recently. This study aims to evaluate the occurrence of AKI during the initial 48 h of ECMO support by using both the RIFLE classification and the AKIN criteria, and to determine which scoring tool has better capability for predicting hospital mortality of adult postcardiotomy patients with ECMO support.
METHODS: From 2004 to 2008, 67 patients (> or = 18 years) who received extracorporeal membrane oxygenation support after undergoing cardiac surgery were enrolled and retrospectively evaluated.
RESULTS: The average age was 50.5+/-13.6 years; 48 patients (72%) were male. According to the RIFLE classification and the AKIN criteria, the incidence of AKI during first 48 h after receiving ECMO support was 81% and 85%, respectively. The overall mortality was 51% and the hospital mortality was much higher among patients who received renal replacement therapy (RRT) than in patients not receiving RRT (73% vs 32%, p=0.001). Either class-Failure for the RIFLE classification (odds ratio (OR)=12.6, 95% confidence interval (CI)=2.2-72.3, p=0.005) or the Stage 3 for the AKIN (OR=30.8, 95% CI=3.3-287.2, p=0.003) was found to be independently associated with the hospital mortality. The area under the receiver operator characteristic (ROC) curve for hospital mortality was 0.738 for the RIFLE classification (p=0.001) and was 0.799 for the AKIN criteria (p<0.001). No significant differences were found in both the incidence of AKI and the hospital mortality of AKI by using the RIFLE/AKIN criteria.
CONCLUSIONS: Acute kidney injury is a major complication and associated with high mortality in adult patients who received ECMO support after undergoing cardiac surgery. Both the RIFLE classification and the AKIN criteria have good short-term prognostic capability in these populations and either class-Failure for the RIFLE classification or the Stage 3 for the AKIN were found to be independently associated with the hospital mortality. However, it does not seem that the AKIN criteria have greater sensitivity and specificity, compared with the RIFLE classification in this study population.
Authors:
Xiaolei Yan; Shijie Jia; Xu Meng; Ping Dong; Ming Jia; Jiuhe Wan; Xiaotong Hou
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2009-08-18
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  37     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-03     Completed Date:  2011-01-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  334-8     Citation Subset:  IM    
Copyright Information:
Copyright 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Affiliation:
Intensive Care Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, PR China.
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MeSH Terms
Descriptor/Qualifier:
Acute Kidney Injury / classification,  diagnosis,  etiology*
Adult
Aged
Cardiac Surgical Procedures*
Epidemiologic Methods
Extracorporeal Membrane Oxygenation / adverse effects*
Female
Humans
Kidney / physiopathology
Male
Middle Aged
Postoperative Care / adverse effects,  methods
Prognosis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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